September 14, 2021
What’s Changing: Blue Cross and Blue Shield of Illinois (BCBSIL) is changing prior authorization requirements that may apply to some commercial, non-HMO members.
As we announced on July 7, 2021, starting Oct. 11, 2021, AIM Specialty Health® (AIM), rather than BCBSIL, will manage prior authorization requests and post-service medical necessity reviews for drugs in the Pharmacy Medical Oncology care category for some BCBSIL members. (Remember: Always check eligibility and benefits first via the Availity® Provider Portal or your preferred vendor before rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.)
Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested isn’t associated with an oncology diagnosis, it will be reviewed by BCBSIL.
For more reminders, key dates and scenarios as we transition to AIM, please refer to the previous announcement. We’ve also listed some quick tips on using the AIM ProviderPortal for pre- and post-service review below.
Tips for Using the AIM ProviderPortal
- Don’t submit medical records to BCBSIL for care categories managed by AIM
- If medical records are needed, AIM will request them via the AIM ProviderPortal
- Use the AIM ProviderPortal to request prior authorization (pre-service)
- Post-service review requests should also be submitted directly to AIM via the ProviderPortal
- Check prior authorization status on the AIM ProviderPortal
AIM’s ProviderPortal Offers End-to-End Efficiencies
- Self-service available 24/7
- Check order status and view order history
- Faster pre-service decision turnaround times than post-service reviews
- Smart clinical algorithms mean real-time determinations, in many cases
- Increases payment certainty
- Transparent feedback before transferring to clinical review
For More Information
Find details about our prior authorization program with AIM at this microsite . Also refer to the Utilization Management section of our website for an updated 2021 Commercial Specialty Pharmacy Prior Authorization Drug List. This list is posted on the Support Materials (Commercial) page.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM or Availity.